The document summarizes strategies for creating and maintaining healthy habits based on psychological science. It discusses four key challenges to meeting public health goals: 1) lack of sufficient motivation, 2) failure to translate intentions into actions, 3) persistence of prior unhealthy habits, and 4) difficulty maintaining new healthy behaviors. It then outlines evidence-based policies and strategies that can address each challenge, including focusing on motivating beliefs, forming effective intentions, disrupting unhealthy habits, and developing routines to establish new habits. Implementing these strategies based on psychological research could help meet goals like those in Healthy People 2020.
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Three appropriate, scholarly journal articles were chosen.
(2 pts.)
The issue is clearly stated in the first paragraph. The summary
is comprehensive and reflects the most important points of the
articles. (4 pts.)
Reflection includes personal and professional reaction to the
content and is clearly stated in the paper. (4 pts.)
Citations within the paper and the reference list are formatted
using APA style. (3 pts.)
Language and grammar usage is accurate. There are a few, if
any, mechanical errors that do not distract from the content of
the paper. (2 pts.)
Grade: ____/15 Comments:
2. Example !
Goals are identified and achieved in both implicit and explicit
levels. However, since we are cognitive misers, we have a
tendency to rely on the automatic processes. This can be
advantageous or disadvantageous as the readings this week
explore these questions in regard to goals and behavior change.
For instance, Rothman et al. (2015), discuss how behavioral
friction can disrupt people’s automatic behaviors and makes it
difficult to continue unhealthy habits. This leaves people now
having to utilize more effortful processing. In the right
contexts, this can yield significant behavior change. Consider
what UHCL has done, they have designated specific smoking
areas around the campus. So now someone that automatically
associates stress with smoking will have to make an effortful
consideration to either expend energy to walk to a smoking
area, reduce smoking, or adopt healthier stress management
techniques. I pose the following question: In what other ways
can we utilize behavioral friction to promote explicit behavior
change? If we induce this behavior change, can we create
dissonance in individuals, and thus cause individuals to commit
to a new goal they deem important (Shah, 2005).
Our deficiency in monitoring our goals can be self-serving at
times. We have a tendency to deceive ourselves with respect to
our progress (Webb et al., 2013). How far do we take it? Do you
think we go as far as to distort our progress (overestimate and
underestimate) to finish (or quit) our goals earlier (Epley,
2014). Briskin et al. (2017) found that participants planned to
spend more time and effort on health/fitness goals when they
perceived their partner as instrumental. This could also be
because their loved ones are more salient, and this could serve
as a reminder they could suffer if one does not take care of
oneself (Rothman et al., 2015). Are goals made with our loved
ones easier to develop a strong engagement in (Higgins, 2005)?
3. Boothby et al. (2014) found that shared sensory experiences are
stronger, so how can this relate to positive behavior change?
Example 2
We all have goals. We all have particular things that will
motivate us to reach these goals. However not everyone wants
to face these problems head on or even at all. In the Rothman
and et al (2015) study on Healthy Habits it talks about how are
reluctant or overconfident about themselves to see a problem
with there health. So if a person is setting a goal to get healthy
but one the window of opportunity to fully engage in a healthy
lifestyle passes them by they will give up or because, they
believe themselves to be invulnerable they will not focus on the
task at hand. So regardless of the type of help they are receiving
from someone Instrumental or emotional support (Briskin and et
al. 2017) it will not help them in attaining their goal. The very
interesting thing from the Briskin and et al. article (2017) on
Outsourcing was how the aspect of partner being a help or a
hinderance to a person. This links in well with Shah (2005) and
" A close relationship may also encourage individuals to
consider, and adopt the goals their significant others are
pursuing themselves" (pg. 11) In essence a close relationship
may very well have both individuals trying to purse the same
goal whether that be health or financial etc. Two heads are
better than one when it comes to reaching a goal right? It did
not seem that way for career goals in the Briskin and et al
(2017) article.
The ostrich problem presented by Webb and et al (2013) suggest
that we do not want to know what is going on with things
sometimes. That our ignorance is bliss. But how could this be?
Why would you not want to know the state of something that
affects your life, or that you are working towards as a goal?
4. They suggest that a low expectancy is something that will help
to keep an individual from looking out for that constant check
up. However I think Rothman and et al (2015) were on to
something with creating habits. Consistency is key when trying
to form a new habit. It is also vital that you find a way to get
away from things that automatically remind you of old habits.
Old habits and bad habits die hard because they are habits and
of course you are so use to them being there in your life. Then
on top of that things that you don't even think of will remind
you of doing things or not doing things depending on what your
habit is. So how dp we push ourselves to do those hard things in
life like telling the truth in a difficult situation? Or telling a
friend that you saw his or her partner being adulterous? Is there
a way to help us as society? Do we all need a little more
instrumental help in our daily lives to support us for times like
these? Sticking your head in the sand doesn't do anything for a
solution to the problem only by addressing the problem can
solutions come forward.
Example !
Goals are identified and achieved in both implicit and explicit
levels. However, since we are cognitive misers, we have a
tendency to rely on the automatic processes. This can be
advantageous or disadvantageous as the readings this week
explore these questions in regard to goals and behavior change.
For instance, Rothman et al. (2015), discuss how behavioral
friction can disrupt people’s automatic behaviors and makes it
difficult to continue unhealthy habits. This leaves people now
having to utilize more effortful processing. In the right
contexts, this can yield significant behavior change. Consider
what UHCL has done, they have designated specific smoking
areas around the campus. So now someone that automatically
associates stress with smoking will have to make an effortful
5. consideration to either expend energy to walk to a smoking
area, reduce smoking, or adopt healthier stress management
techniques. I pose the following question: In what other ways
can we utilize behavioral friction to promote explicit behavior
change? If we induce this behavior change, can we create
dissonance in individuals, and thus cause individuals to commit
to a new goal they deem important (Shah, 2005).
Our deficiency in monitoring our goals can be self-serving at
times. We have a tendency to deceive ourselves with respect to
our progress (Webb et al., 2013). How far do we take it? Do you
think we go as far as to distort our progress (overestimate and
underestimate) to finish (or quit) our goals earlier (Epley,
2014). Briskin et al. (2017) found that participants planned to
spend more time and effort on health/fitness goals when they
perceived their partner as instrumental. This could also be
because their loved ones are more salient, and this could serve
as a reminder they could suffer if one does not take care of
oneself (Rothman et al., 2015). Are goals made with our loved
ones easier to develop a strong engagement in (Higgins, 2005)?
Boothby et al. (2014) found that shared sensory experiences are
stronger, so how can this relate to positive behavior change?
Example 2
We all have goals. We all have particular things that will
motivate us to reach these goals. However not everyone wants
to face these problems head on or even at all. In the Rothman
and et al (2015) study on Healthy Habits it talks about how are
reluctant or overconfident about themselves to see a problem
with there health. So if a person is setting a goal to get healthy
but one the window of opportunity to fully engage in a healthy
lifestyle passes them by they will give up or because, they
believe themselves to be invulnerable they will not focus on the
task at hand. So regardless of the type of help they are receiving
6. from someone Instrumental or emotional support (Briskin and et
al. 2017) it will not help them in attaining their goal. The very
interesting thing from the Briskin and et al. article (2017) on
Outsourcing was how the aspect of partner being a help or a
hinderance to a person. This links in well with Shah (2005) and
" A close relationship may also encourage individuals to
consider, and adopt the goals their significant others are
pursuing themselves" (pg. 11) In essence a close relationship
may very well have both individuals trying to purse the same
goal whether that be health or financial etc. Two heads are
better than one when it comes to reaching a goal right? It did
not seem that way for career goals in the Briskin and et al
(2017) article.
The ostrich problem presented by Webb and et al (2013) suggest
that we do not want to know what is going on with things
sometimes. That our ignorance is bliss. But how could this be?
Why would you not want to know the state of something that
affects your life, or that you are working towards as a goal?
They suggest that a low expectancy is something that will help
to keep an individual from looking out for that constant check
up. However I think Rothman and et al (2015) were on to
something with creating habits. Consistency is key when trying
to form a new habit. It is also vital that you find a way to get
away from things that automatically remind you of old habits.
Old habits and bad habits die hard because they are habits and
of course you are so use to them being there in your life. Then
on top of that things that you don't even think of will remind
you of doing things or not doing things depending on what your
habit is. So how dp we push ourselves to do those hard things in
life like telling the truth in a difficult situation? Or telling a
friend that you saw his or her partner being adulterous? Is there
a way to help us as society? Do we all need a little more
instrumental help in our daily lives to support us for times like
these? Sticking your head in the sand doesn't do anything for a
solution to the problem only by addressing the problem can
7. solutions come forward.
Goals & Motivation
The importance of goalsGoals influence both mundane
decisions, but also larger life decisionsGoals guide responses to
social environmentGoals influence attitudes, moods, and
behaviors of individual
What is a goal?Goal = a cognitive representation of a desired
endpoint that impacts evaluations, emotions, and behaviors
(Ferguson & Fishbach, 2007)
Conscious goal pursuit
Nonconscious goal pursuit – automatic pursuit
Self-Discrepancy Theory (Higgins, 1987)Discrepancies between
actual self and our “ideal” self or “ought” self: serve as
motivationIdeal: who we desire, aspire, hope to beOught: who
we feel a duty, obligation, responsibility to be
Actual – Ideal discrepancy
Actual – Ought discrepancy
8. Regulatory Focus Theory (Higgins, 1997)Promotion focus –
focus on gains, advancementPrevention focus – focus on loss,
stability/security
Chronically and situationally activated
Regulatory fit
Preference for change (Liberman and colleagues)
Nonconscious GoalsGoal-related objects (Ferguson & Bargh,
2004)
Goal Contagion (Aarts et al., 2004)
Goal Shielding (Shah et al., 2002)
Goals & significant others (Shah, 2005)
Temptations (Fishbach & colleagues)
Goals & temptations presented together (complement) vs.
separately (competition; Fishbach & Zhang, 2008)
Goals – temptations link
*
Implementation Intentions (Gollwitzer, 1999)Implementation
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DOI: 10.1177/1745691615598515
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Each decade since 1979, the U.S. Government has speci-
fied national goals regarding the health of the nation; yet
attainment of these goals has proven difficult (e.g.,
National Center for Health Statistics, 2012). Healthy People
2020, launched in December 2010, specified 26 goals
including reducing the rates of obesity, increasing the
rates of colorectal cancer screening, and reducing the
rates of substance use behaviors such as smoking and
binge drinking (U.S. Department of Health and Human
Services, n.d.). According to an update in 2014, 4 out of
the 26 objectives have been met, 10 showed modest
improvement, and 12 showed no improvement or had
gotten worse (Koh, Blakely, & Roper, 2014). As initiatives
are designed and implemented to meet these goals, it is
critical that advances in psychological science guide
these efforts.
Most of the health outcomes identified in these reports
rest on people’s behavior—the actions they take and
those they fail to perform. Underlying these behavioral
patterns is an important, discernable set of challenges.
People fail to take appropriate action even though they
recognize what should be done and intend to take action.
The persistence of unhealthy habits undermines efforts
to perform a new behavior, and even people who initiate
a new pattern of behavior find it difficult to maintain it
long enough to achieve the desired outcome (Rothman,
Sheeran, & Wood, 2009). Fortunately, innovative, evi-
dence-based strategies are available to address each of
these challenges. Investigators have developed strategies
11. that can help people to (a) focus on beliefs that motivate
healthy action, (b) form intentions that are more likely to
lead to healthy action, (c) disrupt the influence of prior
unhealthy habits, and (d) develop routines that lead to
new healthy habits. In the sections that follow, we outline
these strategies and describe how and when these tools
can be used to enhance policies designed to advance
public health.
Strategies That Motivate Action
How should we encourage people to visit the dentist, eat
a healthier diet, or stop smoking? Intervention efforts,
especially those that involve health messages, rest on the
XXX10.1177/1745691615598515Rothman et al.Creating and
Maintaining Healthy Habits
research-article2015
Corresponding Author:
Alexander J. Rothman, Department of Psychology, University of
Minnesota, 75 East River Road, Minneapolis, MN 55405
E-mail: [email protected]
Hale and Hearty Policies: How
Psychological Science Can Create
and Maintain Healthy Habits
Alexander J. Rothman1, Peter M. Gollwitzer2, Adam M. Grant3,
David T. Neal4, Paschal Sheeran5, and Wendy Wood6
1University of Minnesota; 2New York University/University of
Konstanz; 3University of Pennsylvania; 4Catalyst
Behavioral Sciences; 5University of North Carolina at Chapel
Hill; and 6University of Southern California
Abstract
Strategies are needed to ensure that the U.S. Government meets
12. its goals for improving the health of the nation (e.g.,
Healthy People 2020). To date, progress toward these goals has
been undermined by a set of discernible challenges:
People lack sufficient motivation, they frequently fail to
translate healthy intentions into action, their efforts are
undermined by the persistence of prior unhealthy habits, and
they have considerable difficulty maintaining new
healthy patterns of behavior. Guided by advances in
psychological science, we provide innovative, evidence-based
policies that address each of these challenges and, if
implemented, will enhance people’s ability to create and
maintain
healthy behavioral practices.
Keywords
health behavior, intention, maintenance, habits, policy
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702 Rothman et al.
assumption that people will be motivated to modify their
behavior if they understand the costs posed by their
unhealthy habits (Rothman & Salovey, 2007). Yet, psy-
chological science shows that people are reluctant to
recognize personal risks and are overconfident about
their own invulnerability to health problems (Dunning,
Heath, & Suls, 2004). What evidence-based strategies
motivate action while avoiding people’s tendency to min-
imize their own vulnerability?
Thinking about other people can
13. motivate action
An approach that successfully increased hand washing in
hospitals involved emphasizing the impact of one’s beha-
vior on others (Grant & Hofmann, 2011). This contrasts
with the limited success of more standard appeals to
encourage medical professionals to wash their hands,
such as, “Hand hygiene prevents you from catching dis-
eases.” Specifically, when an appeal was altered to refer to
“patients” instead of “you,” rates of hand washing increased
by 10% and soap use increased by 45%. Why is it effective
to shift people’s focus away from consequences for them-
selves and toward consequences for others? People can
easily convince themselves of their own invulnerability,
but they are less motivated and able to do this when judg-
ing others’ risk (Dunning et al., 2004).
Policy implications. Initiatives that focus attention on
consequences for others may be particularly effective in
situations in which messages about personal health conse-
quences are likely to be processed defensively (Dunning
et al., 2004; Rothman & Salovey, 2007). For example, peo-
ple may be motivated to minimize information about their
personal risk for catching the flu and thus show limited
interest in getting a flu shot, but they are willing to
acknowledge and act on information about the health risk
the flu poses to their young children or elderly parents.
People can also be reminded of the indirect consequences
of their health behaviors: If they do not take care of them-
selves, their loved ones may suffer. With this knowledge in
mind, policymakers should modify regulations regarding
signs to promote hand washing in medical facilities and in
eating establishments (i.e., highlighting the impact of the
behavior on patients and customers, respectively). Public
service announcements might similarly encourage people
to quit smoking for their spouses or get flu shots for their
14. parents or children.
Strategies That Aid the Translation of
Intentions Into Action
Even when people decide to take action to improve their
health, there is, on average, only a 50% chance that their
intention will lead to action (Sheeran, 2002). Why is there
a gap? In many cases, people fail to get started—an inten-
tion is forgotten, the opportunity to take action passes, or
confusion about how to act engenders paralysis. In addi-
tion, people’s initial efforts can be derailed—they fall
prey to temptations, distractions, low willpower, or
fatigue (Gollwitzer & Sheeran, 2006).
Bridging the gap between intentions
and action
An evidence-based strategy that can help people get
started and stay on track as they pursue a health goal
is the formation of if–then plans (Gollwitzer, 1999;
Gollwitzer & Sheeran, 2006, 2008). If–then plans provide
a structure in which people (a) identify key opportunities
for, or obstacles to, taking action, (b) specify a way to
respond to each opportunity and obstacle, and then (c)
formalize a link between the opportunity or obstacle and
the response:
“If (opportunity/obstacle) arises, then I will (respond
in this way)!”
Because if–then plans specify in advance when, where,
and how to respond to critical situations, they enable peo-
ple to seize opportunities that they might otherwise miss
and manage obstacles that might otherwise be over-
15. whelming. For instance, patients who wrote down the
plan “If it is [time] and I am in [place], then I take my pill
dose!” took 79% of their medication on schedule as com-
pared with 55% of patients who did not formulate a plan
(Brown, Sheeran, & Reuber, 2009). Similar patterns of
results have been observed across a broad array of health
behaviors ranging from cancer screening (e.g., Neter,
Stein, Barnett-Griness, Rennert, & Hagoel, 2014) to dietary
behavior (Adriaanse et al., 2011) and physical activity
(Bélanger-Gravel, Godin, & Amireault, 2013). Moreover,
if–then plans are especially effective when people find
themselves in circumstances that impair their ability to
translate healthy intentions into action (e.g., limitations in
self-control, Gawrilow, Gollwitzer, & Oettingen, 2011;
feelings of arousal, Webb et al., 2012; or forgetfulness,
Chasteen, Park, & Schwarz, 2001).
Policy implications. If–then plans are easy to deliver
(Oettingen, 2012; see www.woopmylife.org) and can be
readily integrated into a number of policy initiatives. For
example, key documents such as appointment letters,
medication or behavioral prescriptions and instructions,
and health education leaflets should be modified to
include a structured opportunity for people to develop
if–then plans. The benefit of formulating if–then plans
and strategies to support their use should also be
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Creating and Maintaining Healthy Habits 703
integrated into the training provided to healthcare
16. professionals.
Strategies to Disrupt Existing Habits
Even after someone has adopted a new pattern of beha-
vior (e.g., a new diet), older, habitual patterns can linger
and remain a challenging adversary. Because habits
involve memory systems that are relatively separate from
those that represent people’s goals and conscious inten-
tions, old habits do not change immediately when peo-
ple adopt new goals (Walker, Thomas, & Verplanken,
2014). Instead, familiar contexts and routines can bring
the old, unwanted behavior to mind, leaving people at
risk of lapsing back into unhealthy behavior patterns
(Wood & Neal, 2007). What evidence-based strategies
mitigate the continued pull of unhealthy habits and pro-
vide an opportunity for people to sustain a new pattern
of behavior?
One approach involves capitalizing on context
changes in people’s lives (e.g., moving to a new house,
starting a job, having a child). The shifts in context asso-
ciated with these changes reduce people’s exposure to
cues that trigger old habits (Wood, Tam, & Witt, 2005).
Disruptions in old habits can also arise when people
deliberately modify the microenvironments in which they
work and live (e.g., changing the visibility or arrange-
ment of food choices; Sobal & Wansink, 2007) or develop
personalized if–then plans to counter the unwanted
habitual response (Adriaanse et al., 2010).
A second approach involves policies that introduce
behavioral friction to existing contexts that make it harder
for people to follow their unhealthy habits. For example,
with the introduction of smoking bans in UK pubs, peo-
ple with strong habits to smoke while drinking were no
17. longer able to effortlessly light a cigarette when they felt
the urge to smoke (Orbell & Verplanken, 2010). The
behavioral friction induced by having to leave the pub to
smoke may have disrupted the automated associations
between drinking and smoking and, in turn, contributed
to reduced smoking rates. Similarly, with bans on the visi-
ble display of cigarettes in retail environments, potential
purchasers have to remember to deliberately request cig-
arettes in order to buy them (Wakefield, Germain, &
Henriksen, 2008). In both cases, the policy is designed to
make people shift from relying on an automated, reflex-
ive response to a more deliberate, effortful decision.
Policy implications
Policy initiatives can utilize these two different strategies
in a number of ways. First, social marketing campaigns
could be structured to capitalize on opportunities
afforded by changes in people’s work or home environ-
ments. For example, communities could provide free
vouchers for public transportation to people who have
recently moved. Building codes could also be modified
to ensure that healthy behavioral options are salient and,
if possible, the default choice (e.g., salience of stairs vs.
elevators in building entranceways). Second, the
approaches that have been used to disrupt smoking-
related behaviors could be disseminated to settings
where automated, reflexive responses to cues are known
to underlie an unhealthy pattern of behavior. For exam-
ple, restaurants that offer “value meal” packages should
provide a healthy food as the default option (e.g., apple
slices instead of French fries).
Strategies to Develop Routines That
Create New Habits
18. The benefits afforded by changes in health practices such
as increased physical activity only accrue if the change in
behavior is sustained over time; yet people have difficulty
maintaining new patterns of behavior (Rothman, Baldwin,
& Hertel, 2004). What can be done to increase the likeli-
hood that people’s healthy choices develop into new hab-
its? In daily life, people who are able to stick with healthy
behaviors often rely on well-practiced habits that reliably
meet their health goals (Galla & Duckworth, in press). For
example, they might structure their homes with a consis-
tent set of visible cues that promote healthy choices (e.g.,
accessible fresh vegetables) and remove cues that trigger
unhealthy ones (e.g., TVs in bedrooms).
One approach to transforming new behaviors into
strong habits involves facilitating the repetition of the
desired behavior in a stable context (Danner, Aarts, & de
Vries, 2007). For example, when people perform a beha-
vior repeatedly in the same context (e.g., taking a walk
after dinner), over time it becomes sufficiently automated
to be performed without thinking (Lally, Van Jaarsveld,
Potts, & Wardle, 2010). Although the number of repeti-
tions necessary to instill a habit can vary considerably,
once it is formed, people can rely on the well-practiced
behavior to protect them when they are distracted
(Labrecque, Wood, Neal, & Harrington, 2015) or their
willpower is low (Neal, Wood, & Drolet, 2013). Another
approach to automating new behavior involves piggy-
backing a new health behavior onto an existing habit.
For example, dental flossing habits were established most
successfully when people practiced flossing immediately
after they brushed their teeth (rather than before; Judah,
Gardner, & Aunger, 2013; see also, Labrecque et al.,
2015).
19. Policy implications
Forming new habits through repetition in stable contexts
and through piggybacking onto existing habits can inform
the design and dissemination of new policies. First,
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704 Rothman et al.
interventions should be designed to reinforce consistent
behavioral practices (e.g., exercising at the same time
each day). The structure and routines that characterize
school and work environments may make these settings
particularly well suited for this intervention approach. For
example, school policies, especially in elementary schools,
could be structured to reinforce healthy behavior such as
consistent hand washing after using the restroom or
repeated fruit and vegetable consumption during school
lunches (e.g., Lowenstein, Price, & Volpp, 2014). Second,
innumerable opportunities exist to connect a new beha-
vior to an existing habit in people’s daily lives. For exam-
ple, campaigns could link replacing smoke alarm batteries
to when people change the clock for daylight savings or
pair a new health practice (e.g., taking pills) with a daily
habit (e.g., eating dinner).
Summary
Given the important personal and societal benefits that
come from meeting or exceeding the goals identified in
reports such as Healthy People 2020, it is imperative that
20. policy initiatives utilize evidence-based strategies to pro-
mote healthy behavior. The developments in psycholo-
gical science that we have reviewed provide an
evidence-based framework to address challenges that
have confounded past attempts at behavior change.
Because the approaches we have highlighted provide
solutions to specific challenges, investigators should take
care to use them accordingly. To facilitate their applica-
tion, Table 1 summarizes the link between each chal-
lenge and its given solution and provides example policy
recommendations.
Declaration of Conflicting Interests
The authors declared that they had no conflicts of interest with
respect to their authorship or the publication of this article.
Funding
Wendy Wood's research on habits is currently supported by a
grant from the Templeton Foundation: The Neuropsychology
of Developing Good Habits (#52316), Wendy Wood PI, John
Monterosso co-PI.
References
Adriaanse, M. A., Oettingen, G., Gollwitzer, P. M., Hennes,
E. P.,
de Ridder, D. T. D., & de Wit, J. B. F. (2010). When plan-
ning is not enough: Fighting unhealthy snacking habits by
mental contrasting with implementation intentions (MCII).
European Journal of Social Psychology, 40, 1277–1293.
Table 1. How Evidence-Based
21. Solution
s Can Be Used to Address Four Challenges to Successful Health
Behavior Change
Challenges to successful
health behavior change
